|
11-desoxycortisol - sendout
|
$35.00 |
$35.00 |
$35.00 |
$91.85
|
|
17-ketosteroids
|
$30.52 |
$30.52 |
$30.52 |
$55.00
|
|
2d tee w or without fol w/con,in
|
$2,461.00 |
$2,461.00 |
$2,461.00 |
$1,770.60
|
|
2nd order venous cath
|
$7,850.00 |
$7,850.00 |
$7,850.00 |
$1,543.85
|
|
3d ech img cgen car anomal
|
$734.00 |
$734.00 |
$734.00 |
$511.60
|
|
3-d radiotherapy plan
|
$8,293.00 |
$8,293.00 |
$8,293.00 |
$5,002.69
|
|
3d recon without postprocess indpndt
|
$862.00 |
$862.00 |
$862.00 |
$508.13
|
|
5' nucleotidase - sendout
|
$14.37 |
$14.37 |
$14.37 |
$50.05
|
|
88334 ap bill cytologic exam each additional site
|
$103.00 |
$103.00 |
$103.00 |
$100.10
|
|
99381 initial comp preventive med less than 1 year new
|
$218.00 |
$218.00 |
$218.00 |
$135.00
|
|
99382 initial comp preventive med 1 to 4 years new
|
$226.00 |
$226.00 |
$226.00 |
$135.00
|
|
99383 initial comp preventive med 5 to 11 years new
|
$218.00 |
$218.00 |
$218.00 |
$131.00
|
|
99391 periodic comp preventive med less than 1 year est
|
$191.00 |
$191.00 |
$191.00 |
$117.72
|
|
99392 periodic comp preventive med 1 to 4 years est
|
$191.00 |
$191.00 |
$191.00 |
$132.30
|
|
99393 periodic comp preventive med 5 to 11 years est
|
$191.00 |
$191.00 |
$191.00 |
$120.25
|
|
99394 periodic comp preventive med 12 to 17 years est
|
$191.00 |
$191.00 |
$191.00 |
$137.15
|
|
99397 periodic comp preventive med 65+ years est
|
$191.00 |
$191.00 |
$191.00 |
$164.73
|
|
#a/b/c/c/h pnl-candida albicans ab
|
$16.55 |
$16.55 |
$16.55 |
$53.95
|
|
Abd aorta w/runoff s&i
|
$9,334.00 |
$9,334.00 |
$9,334.00 |
$3,667.71
|
|
Abd/low ext cath 1st
|
$12,553.00 |
$12,553.00 |
$12,553.00 |
$2,015.85
|
|
Abd/low ext cath 2nd
|
$6,784.00 |
$6,784.00 |
$6,784.00 |
$2,038.85
|
|
Abd/low ext cath 3rd
|
$13,574.00 |
$13,574.00 |
$13,574.00 |
$2,519.20
|
|
Abd/low ext cath addl
|
$1,153.00 |
$1,153.00 |
$1,153.00 |
$941.20
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (complete)
|
$2,445.00 |
$2,445.00 |
$2,445.00 |
$988.00
|
|
Abdominal and Pelvic Blood Vessel Ultrasound (limited)
|
$1,384.00 |
$1,384.00 |
$1,384.00 |
$662.40
|
|
Abdominal CT scan (with and without contrast)
|
$3,239.00 |
$3,239.00 |
$3,239.00 |
$1,992.00
|
|
Abdominal CT scan (with contrast)
|
$3,046.00 |
$3,046.00 |
$3,046.00 |
$1,669.00
|
|
Abdominal CT scan (without contrast)
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$1,353.32
|
|
Abdominal MRI (with and without contrast)
|
$5,536.00 |
$5,536.00 |
$5,536.00 |
$2,992.50
|
|
Abdominal MRI (with contrast)
|
$5,190.00 |
$5,190.00 |
$5,190.00 |
$2,415.36
|
|
Abdominal MRI (without contrast)
|
$3,636.00 |
$3,636.00 |
$3,636.00 |
$2,048.36
|
|
Abdominal paracentesis w/image guidance
|
$2,672.00 |
$2,672.00 |
$2,672.00 |
$1,646.40
|
|
Abdominal Ultrasound (complete)
|
$1,207.00 |
$1,207.00 |
$1,207.00 |
$783.00
|
|
Abdominal Ultrasound (limited)
|
$930.00 |
$930.00 |
$930.00 |
$586.43
|
|
Abdominal X-ray (2 views)
|
$398.00 |
$398.00 |
$398.00 |
$320.40
|
|
Abdominal X-ray Series (acute, with chest view)
|
$517.00 |
$517.00 |
$517.00 |
$418.63
|
|
Abdominal X-ray (single view)
|
$320.00 |
$320.00 |
$320.00 |
$264.00
|
|
Abd paracentesis/w/o image guide 49082
|
$1,791.00 |
$1,791.00 |
$1,791.00 |
$1,150.80
|
|
Abl1 gene
|
$350.06 |
$350.06 |
$350.06 |
$683.20
|
|
Ablate arrhythmia add on
|
$43,127.00 |
$43,127.00 |
$43,127.00 |
$6,828.51
|
|
Ablate bone tumor(s) cryo perq 20983
|
$26,288.00 |
$26,288.00 |
$26,288.00 |
$9,457.50
|
|
Ablate bone tumor(s) perq
|
$24,741.00 |
$24,741.00 |
$24,741.00 |
$9,707.60
|
|
Ablate heart dysrhythm focus
|
$7,559.00 |
$7,559.00 |
$7,559.00 |
$9,300.87
|
|
Ablate pulm tumor perq crybl
|
$30,602.00 |
$30,602.00 |
$30,602.00 |
$9,977.40
|
|
Ablation cardiac vagal inputs atrium
|
$72,263.00 |
$72,263.00 |
$72,263.00 |
$2,260.30
|
|
Ablation cryo abd perit om
|
$19,044.00 |
$19,044.00 |
$19,044.00 |
$2,335.30
|
|
Ablation cryo adrenal tumor
|
$29,843.00 |
$29,843.00 |
$29,843.00 |
$6,948.75
|
|
Ablation cryo pq liver tumor(s)
|
$29,088.00 |
$29,088.00 |
$29,088.00 |
$8,762.50
|
|
Ablation of upper extremity nerves rf
|
$5,370.00 |
$5,370.00 |
$5,370.00 |
$832.50
|
|
Abscess drain retroperitoneal surg code
|
$6,337.00 |
$6,337.00 |
$6,337.00 |
$3,053.18
|
|
Access & clsr pq fem art endogft dlvry w/img uni
|
$1,425.00 |
$1,425.00 |
$1,425.00 |
$2,314.00
|
|
Access thoracic lymph duct
|
$2,045.00 |
$2,045.00 |
$2,045.00 |
$828.80
|
|
Acetaminophen level
|
$60.00 |
$60.00 |
$60.00 |
$116.80
|
|
Acetylcholinesterase assay
|
$75.00 |
$75.00 |
$75.00 |
$104.40
|
|
Aco annual medicare visit (awv), initial g0438aco
|
$218.00 |
$218.00 |
$218.00 |
$243.00
|
|
Aco annual medicare visit (awv), subsq g0439aco
|
$191.00 |
$191.00 |
$191.00 |
$160.69
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$1,374.00 |
$1,374.00 |
$1,374.00 |
$342.40
|
|
Aco depression screen annual medicare g0444aco
|
$60.00 |
$60.00 |
$60.00 |
$39.32
|
|
Aco med nutria tx/group, ea 30 min 97804aco
|
$65.00 |
$65.00 |
$65.00 |
$40.20
|
|
Acute hepatitis panel
|
$170.00 |
$170.00 |
$170.00 |
$284.70
|
|
#acylcarnitineprfl
|
$44.10 |
$44.10 |
$44.10 |
$118.85
|
|
Admin ecg contrast agent
|
$216.00 |
$216.00 |
$216.00 |
$139.44
|
|
Administration chemotherapy IV infusion each additional hour
|
$1,093.00 |
$1,093.00 |
$1,093.00 |
$230.35
|
|
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr
|
$1,464.00 |
$1,464.00 |
$1,464.00 |
$301.70
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$1,199.00 |
$1,199.00 |
$1,199.00 |
$671.04
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$760.00 |
$760.00 |
$760.00 |
$439.45
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$699.00 |
$699.00 |
$699.00 |
$217.46
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$758.00 |
$758.00 |
$758.00 |
$256.49
|
|
Administration immunization each additional component
|
$44.00 |
$44.00 |
$44.00 |
$35.20
|
|
Administration immunization each additional vaccine
|
$127.00 |
$127.00 |
$127.00 |
$47.60
|
|
Administration immunization first component each vaccine
|
$87.00 |
$87.00 |
$87.00 |
$47.50
|
|
Administration immunization intranasal/oral route 1 vaccine
|
$70.00 |
$70.00 |
$70.00 |
$48.00
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$41.00 |
$41.00 |
$41.00 |
$41.45
|
|
Adrenal cortex & medulla img
|
$2,751.00 |
$2,751.00 |
$2,751.00 |
$2,040.00
|
|
Aep neurodiagnostic i&r
|
$934.00 |
$934.00 |
$934.00 |
$583.80
|
|
Aep thrshld est mlt freq i&r
|
$931.00 |
$931.00 |
$931.00 |
$635.60
|
|
After cataract laser surgery
|
$1,910.00 |
$1,910.00 |
$1,910.00 |
$1,373.11
|
|
Air conduction bilat
|
$415.00 |
$415.00 |
$415.00 |
$134.00
|
|
Albumin body fluid quantitative each specimen
|
$22.00 |
$22.00 |
$22.00 |
$47.45
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$26.00 |
$26.00 |
$26.00 |
$57.60
|
|
Albumin serum plasma or whole blood
|
$22.00 |
$22.00 |
$22.00 |
$42.84
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$45.00 |
$45.00 |
$45.00 |
$96.00
|
|
Alkaline phosphatase
|
$21.00 |
$21.00 |
$21.00 |
$46.80
|
|
Allergen alpha lactalbumin ige
|
$66.00 |
$66.00 |
$66.00 |
$48.60
|
|
Allergen egg white ige
|
$37.00 |
$37.00 |
$37.00 |
$38.00
|
|
Allergen specific ige qual multi scrn ea
|
$100.00 |
$100.00 |
$100.00 |
$24.00
|
|
Allergy injections; 2 or more 95117
|
$99.00 |
$99.00 |
$99.00 |
$47.20
|
|
Allergy injection; single 95115
|
$99.00 |
$99.00 |
$99.00 |
$46.80
|
|
Allergy Skin Testing
|
$43.00 |
$43.00 |
$43.00 |
$47.44
|
|
Allg patch or app # of tests 95044
|
$356.00 |
$356.00 |
$356.00 |
$388.86
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$922.00 |
$922.00 |
$922.00 |
$726.60
|
|
All tstg perq&iq drugs/biol
|
$144.00 |
$144.00 |
$144.00 |
$64.80
|
|
Alpha-fetoprotein amniotic
|
$159.00 |
$159.00 |
$159.00 |
$89.04
|
|
Alpha-fetoprotein tumor marker
|
$74.00 |
$74.00 |
$74.00 |
$105.00
|
|
Alt/sgpt
|
$24.00 |
$24.00 |
$24.00 |
$47.40
|
|
Alys cplx sp/pn npgt w/prgrm
|
$768.00 |
$768.00 |
$768.00 |
$411.45
|
|
Amantadine (symmetrel)-sendout
|
$107.00 |
$107.00 |
$107.00 |
$179.70
|
|
Amitriptyline (elavil) -sendout
|
$187.00 |
$187.00 |
$187.00 |
$87.60
|
|
Ammonia
|
$65.00 |
$65.00 |
$65.00 |
$119.70
|
|
Amniocentesisdiagnostic 59000
|
$2,641.00 |
$2,641.00 |
$2,641.00 |
$943.50
|
